Three Menopause Symptoms Physicians Commonly Overlook, with Lauren Streicher, MD | Ep506

Perplexed by patients with normal exams but persistent symptoms like recurrent UTIs or palpitations? It could be menopause.

In this insightful episode of Succeed In Medicine podcast, host Dr. Bradley Block interviews Dr. Lauren Streicher. They explore commonly overlooked menopause symptoms beyond hot flashes: recurrent urinary tract infections tied to genitourinary syndrome of menopause (GSM), palpitations as "hot flashes of the heart" (often sinus tachycardia without EKG changes), GI microbiome shifts causing nebulous digestive issues, xerostomia (dry mouth) linked to oral health risks, and skin/hair changes like alopecia.

Dr. Streicher emphasizes reassuring patients early, validating symptoms as hormonal, and tailoring treatments, vaginal estrogen, safe even for breast cancer patients, systemic hormones, or new non-hormonal NK3 receptor antagonists like fezolinetant. They discuss the SWAN study's findings on long-term risks from untreated hot flashes (e.g., cardiovascular disease, bone loss), the need to differentiate perimenopausal (temporary) vs. lifelong postmenopausal effects, and avoiding arbitrary hormone therapy stops after 5 years.

The conversation also touches on sexual health gaps in medicine, with tips for better history-taking and resources like Dr. Stryker's "Come Again" course. Listeners, clinicians and patients alike, will gain tools to address menopause holistically, improving quality of life and preventing complications.

Three Actionable Takeaways:

• Recognize GSM in Recurrent UTIs: For postmenopausal women with new-onset recurrent UTIs, suspect genitourinary syndrome of menopause, prescribe local vaginal estrogen (cream, suppository, or ring) to restore microbiome and tissue health; it's safe for most, including breast cancer survivors on aromatase inhibitors.
• Reassure on Palpitations First: When midlife women present with palpitations, lead with "This is common in perimenopause (up to 50% affected) likely autonomic dysfunction like a 'heart hot flash'"; order a Holter monitor, but emphasize it's often benign and tied to vasomotor symptoms, treatable with hormones or NK3 antagonists.
• Integrate Sexual History Properly: Ditch "Are you sexually active?",  ask "Many women in menopause experience low libido, pain with sex, or orgasm difficulty; are any of these issues for you?"; refer to resources like Dr. Streicher's course for evaluation scripts, screeners, and solutions to address 50% of patients' unspoken concerns.

About the Show:

Succeed In Medicine covers patient interactions, burnout, career growth, personal finance, and more. If you're tired of dull medical lectures, tune in for real-world lessons we should have learned in med school!

About the Guest:

Dr. Lauren Streicher is a clinical professor of OB-GYN at Northwestern University and founding director of its Center for Sexual Medicine and Menopause. A certified menopause practitioner, she serves on the Menopause journal's editorial board, is a Kinsey Institute fellow, and authors bestsellers like "Sex Rx" and "Hot Flash Hell." She hosts "Inside Information" podcast and created "Come Again" audio series on postmenopausal sexuality.

Connect with Dr. Lauren Streicher:

Website: https://www.drstreicher.com

Email: info@drstreicher.com 

About the Host:

Dr. Bradley Block – Dr. Bradley Block is a board-certified otolaryngologist at ENT and Allergy Associates in Garden City, NY. He specializes in adult and pediatric ENT, with interests in sinusitis and obstructive sleep apnea. Dr. Block also hosts Succeed In Medicine podcast, focusing on personal and professional development for physicians

Want to be a guest?

Email Brad at brad@physiciansguidetodoctoring.com  or visit www.physiciansguidetodoctoring.com to learn more!

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This medical podcast is your physician mentor to fill the gaps in your medical education. We cover physician soft skills, charting, interpersonal skills, doctor finance, doctor mental health, medical decisions, physician parenting, physician executive skills, navigating your doctor career, and medical professional development. This is critical CME for physicians, but without the credits (yet). A proud founding member of the Doctor Podcast Network!

Visit www.physiciansguidetodoctoring.com to connect, dive deeper, and keep the conversation going. Let’s grow! 

Disclaimer:

This podcast is for informational purposes only and is not a substitute for professional medical, financial, or legal advice. Always consult a qualified professional for personalized guidance.

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